Healthcare Provider Details

I. General information

NPI: 1619954195
Provider Name (Legal Business Name): MOSES PREISER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE DEPT OF PSYCHOLOGY G BLDG 6 FL RM 6302
BROOKLYN NY
11203-2057
US

IV. Provider business mailing address

1052 E 29TH ST
BROOKLYN NY
11210-3744
US

V. Phone/Fax

Practice location:
  • Phone: 718-951-7204
  • Fax:
Mailing address:
  • Phone: 718-951-7204
  • Fax: 718-951-7204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005109-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: